Healthcare Provider Details

I. General information

NPI: 1164643730
Provider Name (Legal Business Name): SHIRLEY MAE WEST RN, CCM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5555 GLENDON COURT
DUBLIN OH
43016
US

IV. Provider business mailing address

7358 THOMPSON ROAD
CINCINNATI OH
45247
US

V. Phone/Fax

Practice location:
  • Phone: 513-385-2742
  • Fax: 513-385-2746
Mailing address:
  • Phone: 513-353-3366
  • Fax: 513-353-3366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN 206103
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: